Kate Dale, Mental/Physical Health Lead, Bradford District Care Foundation Trust (BDCFT) BSc RMN

You & Your Carewww.bdct.nhs.uk

Improving the Quality of

Physical Health Checks

Kate Dale, Mental/Physical Health Project Lead BDCFT


Research• The most notable is a shorter lifespan,

reduced by around 20 years compared to the general population

• There is considerable evidence that one of the main causes of early death in people with SMI is cardiovascular disease

• Other physical causes include cancer

• Patients with Severe Mental Illness (SMI) experience health inequalities.



Disability Rights Commission

People with mental health problems experience

‘diagnostic overshadowing’: that is, reports of

physical ill-health being viewed as part of the

mental health problem or learning disability, and so

not investigated or treated.


The Quality and

Outcomes Framework (QOF)A physical health check within the last 12 months

Until recently did not specify what the health check should include.

Recommends:

Recording Alcohol consumption

BMI

BP

Cholesterol/HDL

Blood Glucose

Cytology Recordings

However it does not specify interventions


Present QOF

• BP

• Alcohol

• Cervical Screening

• Lithium


Mental/Physical Health

QoF IndicatorsPhysical health to be reviewed at 12 monthly intervals.The review includes a check on accuracy of any prescribed medication Side effect monitoring

Review of physical healthReview of co-ordination arrangements with

secondary careLithium monitoringThe practice has a (SMI) register.


National Institute for Clinical

Excellence (NICE)

• Offers guidance for:

• bipolar disorder(CG38)

• Schizophrenia (CG82)


Proposal to address health

inequalities in the SMI population

in Bradford• A more specific standardised data entry template

based on existing mental health QOF indicator

• Specific to areas of physical health risks prevalent to those with SMI

• More specific tests e.g. blood tests for diabetes, cholesterol, ECG and other appropriate tests.

• Auditable across the whole city using the SystmOne primary care information system


Audit Outcome

• 12 practices audited

• Using QOF SMI registers

• 20% of each register

• Random sample

• Total of 104 patients included

• Anonymous

• 42% female 58% male


Audit Findings• No patients had been given a cardiovascular

risk calculation

• This would be a good way to identify high risk people for prevention

• No patients had a blood test for prolactin levels

• (elevated prolactin is a significant and common adverse effect of antipsychotic treatment)


The SystmOne Physical Health Check

Template






RIO Version

Now Live in Secondary Care

New Physical Health/Wellbeing Clinics in 5

CMHTs Across BDCFT




Experiences

• 13 years!

• Relationships.

• Education.

• Support.

• Standardised

• Meaningful.


Barriers

• Fear.

• Workload

• Technology (Morrison's & Sainsbury’s)

• Knowledge.

• Expectations (Going the extra mile).

• Support

• Time


Learning

• People.

• Resistant

• Core groups

• Avoid working on own (standardisation).

• Loosing Confidence.

• Focus

• Communication.


Where we are now

• Rolled out to All GP practices.

• Replicated on different IT systems

• Opened 5 clinics in secondary care.

• Rolled out in all in patient areas

• Communicated to GP electronically for

inpatient discharges.


Where we are now cont…..

Rolled out physical health training to all band 2,3,4 (Calderdale)

RAMPPS

Link workers.

Standardised Simple Kits on all areas.

ECG

Smoke Free


Recognition Local & National

• Endorsed by Geraldine Strathdee (National

Director for Mental Health NHS England)

• Adopted across various sites in England

• AHSN (Yorkshire and Humber)supporting

roll out regionally

• Supported by NHSIQ

• NHS Education England


Interested Organisations So Far!

• Greater Manchester West Mental Health NHS Foundation Trust,

• NHS HARDWICK CCG

• South East Leeds Community Mental Health Services

• Oxford Health NHS Foundation Trust

• Older People’s and Urgent Care Services Oxfordshire


Interested Organisations

• South Central and West Commissioning Support Castlewood

• NHS Southern Derbyshire Clinical Commissioning Group

• Midlands and Lancashire CSU


Thank you very much for

listeningContact details:

[email protected]

[email protected]

Please do not hesitate to contact us for further information.

mailto:[email protected]

Healthcare

Kate Dale, Mental/Physical Health Lead, Bradford District Care Foundation Trust (BDCFT) BSc RMN